Multimodal techniques for smoking cessation: a review of their efficacy and utilisation and clinical practice guidelines

Department of Psychiatry, University of California School of Medicine, Langley Porter Neuropsychiatric Institute, San Francisco, CA 94143-0984, USA.
International Journal of Clinical Practice (Impact Factor: 2.54). 10/2008; 62(11):1753-68. DOI: 10.1111/j.1742-1241.2008.01885.x
Source: PubMed

ABSTRACT Nicotine addiction is a complex, chronic condition with physiological and psychological/behavioural aspects that make smoking cessation extremely difficult. This paper reviews current recommendations for smoking cessation and the efficacy of pharmacotherapy and behavioural modification techniques, used either alone or in combination, for smoking cessation.
Abstinence rates for pharmacotherapies range from approximately 16% to approximately 30% at 1-year follow-up, with efficacy odds ratios (ORs) compared with placebo of approximately 1.7 for nicotine replacement therapy (NRT), approximately 1.9 for bupropion sustained release and approximately 3.0 for varenicline. Behaviour modification therapies have achieved quit rates of between 8% and 43% for up to 1 year, with ORs in comparison to no treatment of between approximately 1.2 and approximately 2.2. No direct comparisons have been made between pharmacotherapy alone and psychological behaviour strategies alone. However, combining physiological approaches with counselling significantly increases the odds of quitting compared with either technique alone.
Applying multimodal techniques for the treatment of nicotine addiction is the recommended approach and has demonstrated the potential to improve rates of permanent abstinence in smokers attempting cessation. While the numbers of patients receiving help and advice regarding smoking cessation is increasing, the multimodal approach appears to be currently underutilised by clinicians and therefore smoking cessation strategies are not being optimised.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: After a 40-year hiatus there is now a revisiting of psychedelic drug therapy throughout psychiatry, with studies examining the drugs psilocybin, ketamine, ibogaine and ayahuasca in the treatment of drug dependence. Limitations to these therapies are both clinical and legal, but the possibility of improving outcomes for patients with substance dependency imposes an obligation to research this area. Royal College of Psychiatrists.
    The British journal of psychiatry: the journal of mental science 01/2015; 206(1):1-3. DOI:10.1192/bjp.bp.114.148031 · 7.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To explore cultural context for smoking cessation within Chinese communities in Vancouver, and identify opportunities to support development of culturally appropriate resources for cessation. Methods: Applied participatory approach involving community members, patients, and key-informants in the design and implementation of the research. Results: Whereas many participants were motivated to quit, their perceptions of desire to do so were not supported by effective interventions and many attempts to quit were unsuccessful. Conclusion: Tobacco control clinics and care providers need to adopt culturally and linguistically relevant interventions to facilitate behavioral modifications and cessation in ethnic minority communities.
    American journal of health behavior 06/2014; 38(5):657-67. DOI:10.5993/AJHB.38.5.3 · 1.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tobacco use is the leading cause of preventable death. Although the health risks are well known, cessation rates remain low. Whereas behavioral and neuroanatomical studies on tobacco addiction conventionally use nicotine, there is evidence that other constituents, such as monoamine oxidase inhibitors, may be important factors for modeling smoking. The aims of the present study were therefore to determine whether norharmane, a tobacco constituent and monoamine oxidase inhibitor, is self-administered alone and/or in combination with nicotine, and to evaluate the neural mechanisms underlying acquisition of self-administration of the two drugs. Sprague-Dawley rats were catheterized and allowed to intravenously self-administer either saline, nicotine (7.5 μg/kg/inj), norharmane (0.25 or 2.5 μg/kg/inj), alone or combined together (7.5+2.5 μg/kg/inj) for five days at fixed ratio (FR)1, two days each at FR2 and FR5, and one day at progressive ratio. Animals acquired self-administration of norharmane alone (2.5 μg/kg/inj), and the reinforcing effects of nicotine and norharmane were additive. For neuroanatomical analyses, rats self-administered the same treatments for six days at FR1, then brains were collected and processed by in situ hybridization for cfos mRNA expression. Treatment-specific profiles of regional cfos expression and correlations between cfos mRNA levels and behavioral responding were observed. Thus, not only was norharmane behaviorally reinforcing but, when combined with nicotine, resulted in patterns of neural activation distinct from that of norharmane or nicotine alone. This suggests that non-nicotine constituents can have central activating effects independent of nicotine, further substantiating the need for their inclusion in preclinical investigations of tobacco dependence.
    Neuropharmacology 06/2014; 85. DOI:10.1016/j.neuropharm.2014.05.035 · 4.82 Impact Factor